Objective

To describe the frequency and characteristics of proton pump inhibitor (PPI) use before the age of 1 year and its evolution over time in France.

Study Design

This cohort study, based on the EPI-MERES register built from the French National Health Data System (SNDS), included children born in 2010-2021. PPI use was identified through prescriptions before age 1. Logistic regression models were used to assess factors associated with PPI use, including demographic and socioeconomic characteristics, medical characteristics, and healthcare use indicators.

Results

Among the 8,222,100 children included, 703,891 were PPI users. The incidence of PPI use was 54.4 per 100 person-years among children with hospital-diagnosed gastro-oesophageal reflux disease (GERD) (+33.6% between 2010 and 2021), and 7.9 per 100 person-years in those without (+63.6%). In children without an inpatient diagnosis of GERD, PPI use was associated with known risk factors of GERD (extreme prematurity, adjusted odds ratio 1.91 [95% CI 1.82-2.01]; digestive diseases, 5.60 [5.49-5.71]; respiratory diseases, 2.73 [2.70-2.75]; neurological diseases 1.59 [1.56-1.62]), and with high maternal socioeconomic level (1st quintile of deprivation index [least deprived] vs 5th quintile [most deprived], 1.80 [1.79-1.82]; monthly salary ≥2,000 euros vs beneficiaries of the complementary solidarity health insurance, 1.92 [1.91-1.94]).

Conclusion

PPI use before age 1 has increased sharply in France since 2010, particularly in infants without an inpatient diagnosis of GERD. Beyond known risk factors for GERD, it was associated with high maternal socioeconomic level. Further work to understand the determinants of PPI prescribing is essential to reduce unnecessary exposure.